Objective Hemodynamic Cardiovascular Autonomic Abnormalities in Post-Acute Sequelae of COVID-19

Hira, Rashmin; Baker, Jacquie; Siddiqui, Tanya; Ranada, Shaun; Soroush, Ateyeh; Karalasingham, Kavithra; Ahmad, Hyeqa; Mavai, Vibhuti; Valani, Luciano Martin Ayala; Ambreen, Sakina; Bourne, Kate; Lloyd, Matthew G.; Morillo, Carlos A.; Sheldon, Robert S.; Raj, Satish R.

doi:10.1016/j.cjca.2022.12.002

Cited by 27 publications

(37 citation statements)

References 42 publications

(53 reference statements)

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“…Given that either SARS-CoV-2 infection or COVID-19 vaccination can trigger POTS and other cardiovascular dysautonomias, it has been hypothesized that these factors might be potent immune triggers that evoke an autoimmune response in susceptible individuals. Moreover, the occurrence of these cardiovascular dysautonomias seems to be unrelated to the severity of initial infection 4 . Future research might reveal an immunomodulating agent that abates the hypothetically overstimulated or misdirected immune response.…”

mentioning

confidence: 97%

“…Other variations of cardiovascular autonomic dysfunction, such as inappropriate sinus tachycardia, were also reported 3 . POTS is considered to be a major phenotype in the new post-acute COVID-19 syndrome, with an estimated prevalence of ~30% among highly symptomatic patients 4 , but other forms of cardiovascular dysautonomia, such as orthostatic intolerance or hypotension and vasovagal reflex susceptibility, have been also reported 5 .…”

mentioning

confidence: 99%

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Autonomic dysfunction and postural orthostatic tachycardia syndrome in post-acute COVID-19 syndrome

Fedorowski

Sutton

2023

Nat Rev Cardiol

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The post-acute sequelae of COVID-19 present major problems for many patients, their physicians and the health-care system. They are unrelated to the severity of the initial infection, are often highly symptomatic and can occur after vaccination. Many sequelae involve cardiovascular autonomic dysfunction, with postural orthostatic tachycardia syndrome in 30% of individuals. Prognosis is unknown, and treatment is still unsatisfactory.

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confidence: 97%

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confidence: 99%

Autonomic dysfunction and postural orthostatic tachycardia syndrome in post-acute COVID-19 syndrome

Fedorowski

Sutton

2023

Nat Rev Cardiol

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“…Consequently, given that neither FND nor Long COVID has a definitive test, an FND diagnosis can lead to no access to Long COVID-related care and patients being dismissed despite some similarities in the presentation and ongoing symptoms. Other factors at play can be that dysautonomia, such as PoTS [ 33 ], which are very common in Long COVID [ 34 ], require expert knowledge to differentiate with FND.…”

Section: Resultsmentioning

confidence: 99%

Neurological Dysfunction in Long COVID Should Not Be Labelled as Functional Neurological Disorder

Feltz-Cornelis

Moriarty

Strain

2023

Viruses

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There have been suggestions that Long COVID might be purely functional (meaning psychological) in origin. Labelling patients with neurological dysfunction in Long COVID as having functional neurological disorder (FND) in the absence of proper testing may be symptomatic of that line of thought. This practice is problematic for Long COVID patients, as motor and balance symptoms have been reported to occur in Long COVID frequently. FND is characterized by the presentation of symptoms that seem neurological but lack compatibility of the symptom with a neurological substrate. Although diagnostic classification according to the ICD-11 and DSM-5-TR is dependent predominantly on the exclusion of any other medical condition that could account for the symptoms, current neurological practice of FND classification allows for such comorbidity. As a consequence, Long COVID patients with motor and balance symptoms mislabeled as FND have no longer access to Long COVID care, whereas treatment for FND is seldom provided and is ineffective. Research into underlying mechanisms and diagnostic methods should explore how to determine whether motor and balance symptoms currently diagnosed as FND should be considered one part of Long COVID symptoms, in other words, one component of symptomatology, and in which cases they correctly represent FND. Research into rehabilitation models, treatment and integrated care are needed, which should take into account biological underpinnings as well as possible psychological mechanisms and the patient perspective.

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“…In an overview of symptoms in an international cohort of patients with PASC, Dr. Davis et al reported that fatigue, postexertional malaise, palpitations, tachycardia, and chest pain were among the most common symptoms, present in 60%–90% of patients with PASC. 32 Dr. Hira et al 33 report frequent cardiovascular autonomic abnormalities in patients with PASC, with 30% of female patients diagnosed with POTS. These cohort studies support the cardiotropic nature of SARS-CoV2 and a potential link with POTS and other forms of dysautonomia.…”

Section: Discussionmentioning

confidence: 99%

“…28 Although accurate epidemiologic data are lacking, large health care systems comparing the incidence in the days before and after the index diagnosis show a significant increase in cardiovascular abnormalities including POTS, dysautonomia, tachycardia, or palpitations with COVID-19. [29][30][31][32][33] Dr. Xie et al analyzed the cardiovascular outcomes of a large cohort of Veterans in the year after the diagnosis of COVID-19 as compared with historical controls and noninfected cohorts and described a significant increase across a wide spectrum of cardiovascular complications including tachyarrhythmias. 29 In an effort to compare the complications of SARS-CoV2 vaccine with that of COVID-19, Barda et al 30 reported on the incidence of new cardiovascular diagnoses within 42 days of SARS-CoV2 infection, and although they did not specifically assess for POTS, tachycardia, or dysautonomia, a significant increase in arrhythmias was described.…”

Section: Viral Infections and Potsmentioning

confidence: 99%

Postural Orthostatic Tachycardia Syndrome After COVID-19: a Systematic Review of Therapeutic Interventions

Abbate

Iulio

Thomas

et al. 2023

Journal of Cardiovascular Pharmacology

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Postural orthostatic tachycardia syndrome (POTS) is a clinical syndrome of inappropriate increase in heart rate on standing that has been recently also associated with Coronavirus Disease 2019 (COVID-19) as part of the postacute sequelae of COVID-19 (PASC) or long-COVID. We herein aimed to systematically review reported cases of POTS after COVID-19 and determine the characteristics of the subjects, the diagnostic approach used, and the treatment strategies. We searched the literature according to the following criteria: (1) diagnosis of POTS according to standard definition; (2) timely association with a probable or definite diagnosis of COVID-19; and (3) a description of the individual subject(s). We identified 21 reports meeting criteria between March 2020 and September 2022, including 68 subjects (51 females and 17 males, 3:1 ratio) with a mean age of 34 ± 12 years, with reports deriving from the United States, Norway, Sweden, Israel, Ireland, United Kingdom, Singapore, and Japan. Most cases had mild COVID-19 symptoms. The most common POTS symptoms were palpitations, chest pain, lightheadedness, and debilitating fatigue. The diagnosis was established by means of head-up tilt table or active stand test. Nonpharmacologic treatments (fluids, sodium intake, and compression stockings) were virtually always used, but largely ineffective. Subjects received different treatments, the most common being beta-adrenergic blockers (ie, propranolol), mineral corticosteroids (ie, fludrocortisone), midodrine, and ivabradine. Symptoms tended to improve over time, but most patients remained symptomatic for several months. In conclusion, POTS after COVID-19 is a clinical condition affecting young individuals, and disproportionately young women, occurring as part of PASC—long-COVID, often debilitating, which can be easily diagnosed with a thorough clinical assessment and measuring changes in orthostatic heart rate and blood pressure. POTS after COVID-19 seems to be poorly responsive to nonpharmacological treatments but with symptoms improving with pharmacological interventions. Given the limited data available, additional research is urgently needed with respect to its epidemiology, pathophysiology, and treatments.

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Objective Hemodynamic Cardiovascular Autonomic Abnormalities in Post-Acute Sequelae of COVID-19

Cited by 27 publications

References 42 publications

Autonomic dysfunction and postural orthostatic tachycardia syndrome in post-acute COVID-19 syndrome

Autonomic dysfunction and postural orthostatic tachycardia syndrome in post-acute COVID-19 syndrome

Neurological Dysfunction in Long COVID Should Not Be Labelled as Functional Neurological Disorder

Postural Orthostatic Tachycardia Syndrome After COVID-19: a Systematic Review of Therapeutic Interventions

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